Provider Demographics
NPI:1578512646
Name:HERROLD, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HERROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MEDICAL PARK PL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8099
Mailing Address - Country:US
Mailing Address - Phone:501-623-2500
Mailing Address - Fax:501-623-5155
Practice Address - Street 1:135 MEDICAL PARK PL
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8099
Practice Address - Country:US
Practice Address - Phone:501-623-2500
Practice Address - Fax:501-623-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6620208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19666Medicare UPIN